Presentation (CTI)

OBJECTIVES: Colorectal cancer (CRC) is a leading cause of morbidity and mortality in the U.S. with rising incidence among individuals aged <50 prompting guideline lowering by the 2021 U.S. Preventive Services Task Force from age 50 to 45. This study evaluated real-world changes in screening among U.S. adults aged 45-74 before and after guideline updates
METHODS: The MORE² Registry, a nationally representative claims database, was leveraged for this analysis. Annual CRC screening rates from 2016 to 2025 were estimated in 5-year age bands among individuals aged 45-74. Eligible individuals (denominators) had continuous enrollment during each measurement year and the year prior, no high-risk CRC conditions during the prior year, and no CRC diagnosis the prior 6 years. Numerators included individuals who received CRC guideline-recommended screening modalities (e.g. colonoscopy, stool-based tests) during the measurement year. All results were summarized descriptively
RESULTS: Among US adults aged 45-74, overall screening rates increased from 10.2% in 2016 to 11.1% in 2025, peaking at 12.2% in 2023. The greatest increase was observed in the newly targeted cohort aged 45-49, with rates rising from 2.8% in 2020 pre-guideline expansion to 4.5% in 2021, 7.6% in 2022 and 11.2% in 2023; overall, this cohort saw a 155% increase from 4.2% in 2016 to 10.7% in 2025. In contrast, screening rates for the 50-54 cohort who were eligible prior to the expansion remained relatively flat (11.3% in 2016 to 10.9% in 2025). Adults aged 70-74 consistently had the highest rates (13.6% in 2016; 14.4% in 2025).
CONCLUSIONS: Despite declines in screening during the COVID-19 pandemic in 2020, updated guidelines were associated with increased screening among younger adults. Persistently low overall screening rates highlight a systemic gap, underscoring the need for comprehensive, multi-level public health strategies to reduce preventable CRC mortality and overall patient and health system burden.